Androgen deprivation therapy (ADT) is an effective treatment used in approximately 30% of men with prostate cancer, however is associated with multiple adverse endocrine effects due to profound hypogonadism. In addition to sexual dysfunction, fatigue and hot flushes, sarcopaenic obesity also significantly contributes to increased cardiovascular risk, and importantly, poor quality of life. Accelerated bone loss also occurs in association with an increase in fracture risk, hence optimization of musculoskeletal health in addition to preventing fat gain in men undergoing ADT is crucial. Adverse-effects can persist for many years after cessation of ADT. The role of exercise, and current and emerging anabolic therapies for muscle as well as various new strategies to prevent loss of bone mass in men undergoing ADT will be discussed. Given excellent cancer-specific survival in men with prostate cancer, additional strategies to improve quality of life including treatments for hot flushes, depression and sexual dysfunction must also be considered. Men undergoing ADT for prostate cancer require a multidisciplinary co-ordinated approach to care.